Jennifer Kim

Women in drug development continue to be underrepresented in leadership roles. Although various reasons have been given for this disparity, one possible explanation concerns gender-based microaggressions experienced by women in the workplace. To investigate this proposed cause of gender disparities in the drug development workforce, Tufts Center for the Study of Drug Development conducted 26 interviews among a diverse group of women professionals in drug development. These interviews focused on participants’ experience with microaggressions in the workplace and the effect of these microaggressions on teamwork and communication. The research team found that gender-based microaggressions in the drug development workplace can negatively impact collaboration among teams and can affect retention of women employees.

Drug development is among the many areas within Science, Technology, Engineering, and Math (STEM) where women professionals continue to be underrepresented. Although the gender diversity in the drug development industry has improved over the years, women, and particularly women of color, are still noticeably underrepresented in leadership roles. Only 30% of all C-suite positions are filled by women, with a mere 4% of this group representing women of color.

 There have been many reasons put forth to explain this gap, including perceived role incongruity between women and male-typed jobs,

 and deeply entrenched systemic barriers.

 Another contributing factor to this gap are gender microaggressions, defined as subtle behaviors and comments that most often unintentionally demean or denigrate individuals based on their gender.

 Though subtle, microaggressions are ubiquitous, occurring daily in the lives of women in the workplace. Though some argue that microaggressions are harmless, amounting to nothing more than minor insults,

 the emerging research on workplace gender microaggressions has demonstrated their deleterious effects on both cognitive and affective outcomes on women professionals.

Naturally, we wondered how gender microaggressions might manifest in drug development and what impact they might have on women professionals navigating this industry. To shed light on this topic, Tufts Center for the Study of Drug Development recently conducted a qualitative study to examine how gender microaggressions manifest among different work teams in drug development. We interviewed a total of 26 women across different areas, including sponsor organizations, contract research organizations (CROs), vendors, and academic research centers, representing a variety of different functions, levels, and work experience. Importantly, our sample was also racially diverse: 50% were women of color representing Asian, Black, Latina and multi-racial women, allowing us to capture nuanced ways gender microaggressions manifest for women of color.

Of the different types of microaggressions that we uncovered, devaluation emerged as a common form of slight that women encountered on a regular basis. Devaluation describes behaviors or comments that put down or diminish a woman’s input or contribution, the most common example being interrupting women while they speak or misattributing their work to a male colleague. These experiences were shared unanimously across the diverse sample of women we interviewed.

Our study’s racially diverse sample provided important nuance to how gender microaggressions manifest for women of color. Women of color not only had to contend with the usual forms of gender microaggressions, such as devaluation and misattribution of work, but also had to navigate an added layer of microaggressions that intersected their gender and racial identities. These included unsolicited comments that otherized different aspects of their racial and ethnic identity (i.e., colleagues repeatedly mispronouncing their names and being mistaken for another woman of color). Important distinctions also emerged within our racially diverse sample. Black women shared how they felt otherized by belabored comments from colleagues about their hair that made them feel uncomfortably spotlighted. Assumptions of incompetence and lack of intelligence for Black and Latina women also emerged. Conversely, Asian women were assumed to be overly competent, which was often accompanied by the assumption that they do not need resources or help or that they are naturally experts in data analysis even if they were not.

The potential impact of gender microaggressions on team productivity

Regularly experiencing these types of slights were linked with cognitive depletion, emotional exhaustion, and behavioral changes, including overcompensation as well as withdrawal. Importantly, constantly navigating these dynamics was also associated with lowered productivity and team performance, stemming largely from lowered trust towards and a tendency to limit one’s interactions with the aggressor. Naturally, this can pose a challenge to team productivity and effectiveness, which we detail below.

Lowered trust towards one’s colleague can lead to decreased information sharing and communication, which are hallmarks of effective teams.

 This is particularly worrisome within the context of drug development given the collaborative nature of many cross-functional teams whose success depends on effective communication and idea sharing.

Moreover, several of the behaviors that women encountered, such as interruptions or misattribution of their work were directly linked to lowered productivity. In one example, a project manager (PM) described a situation in which the Principal Investigator (PI) would constantly email her male colleague about her project. Repeated incidents such as this created redundancy and delays in the project, all of which could have been avoided had the PI reached out to the correct PM, in this case, the woman.

Such interactions that we have described so far may seem minor at first blush. However, when experienced on a regular basis at work among one’s colleagues, the psychological and emotional toll can be taxing. In fact, the growing research on workplace microaggressions has linked these interactions to emotional and cognitive exhaustion as women manage their emotions while they decipher the meaning and intent behind many of these often-unintentional slights that are committed unbeknownst by the aggressor.

 Though unintentional, these micro interactions have the potential to have macro effects if left unchecked. In fact, many of the women in our sample talked about their intent to leave the organization, and many of them had, at the time of the interview, recently left what they viewed as toxic and exclusionary teams and organizations. Losing talent is the ultimate cost to teams and organizations as it can result in a “brain drain” of diverse, high potential talent.

What then can organizations do to address these all-too-common forms of team dynamics? The solution is creating an inclusive organizational culture where individuals, regardless of their background, feel welcomed and have the potential to develop and grow. However, creating such an environment is easier said than done. While many organizations have heeded the calls for more inclusive workplaces by organizing Diversity, Equity, and Inclusion (DEI) panels, talks, and workshops, etc. such efforts will fall short if they are not accompanied by an intentional and systematic way of benchmarking progress. After all, how does one know there is a problem when one does not measure it? How does one know there is improvement if there are no metrics to track over time? While tracking personnel data, such as turnover statistics, is vital, such statistics would be well paired with antecedent indicators that can help predict and prevent the loss of diverse talent.

We propose measuring the occurrence of these dynamics within organizations and teams to identify areas that need resources related to training and dialoguing. We believe that microaggressions are best addressed through conversation and perspective-taking. The ability to measure and track these dynamics can serve organizations well as they can “get ahead of the problem.”

Cross collaboration is increasingly necessary for producing high quality science.

 Microaggressions, however, can hinder team effectiveness by stifling communication, trust, and cohesion among teams. Further, these dynamics can signal exclusion, ultimately contributing qualified women to leave such organizations or quit the industry altogether in search of more inclusive environments. Thus, the ability to identify, measure, and benchmark these dynamics can help organizations take a more proactive approach to ensure that they are creating an inclusive environment where all individuals, regardless of their social identity, can thrive.

Corresponding Author, Tufts Center for the Study of Drug Development, Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111. 

This study was conducted through a research grant from PhRMA.

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Articles

26 interviews conducted by Tufts CSDD found that gender-based microaggressions can negatively impact collaboration and affect retention of women employees.

The Impact of Gender Microaggressions on Team Performance in Drug Development

During the past decade, there has been unprecedented focus on patient-centric initiatives in support of drug development planning and execution. The original intent of these initiatives was to amplify patient input, address patient needs and preferences, and ensure that patients have the best possible experience participating in clinical trials. As investment and experience with patient centric initiatives has evolved, a growing number of organizations have looked to measure the impact of patient-centric activities on a variety of clinical trial outcomes includingspeed and quality.

 Although these outcome measures inform project management, resource allocation and return-on-investment decisions, they are ‘trial-centric’; they are not patient centric.

Key indicators of patient experience—most notably satisfaction—are largely missing from the outcome measures that organizations are systematically gathering. Such routine assessment of patient satisfaction is essential to measuring the successful implementation of patient-centric initiatives and to informing continuous improvement of these initiatives.

The purpose of this article is to remind clinical research stakeholders to re-prioritize routine assessment of patient satisfaction as a primary outcome measure and to inform how to approach that assessment.

Patient satisfaction is not a new concept. It has been covered extensively in the medical science literature. Studies have consistently shown that there exists a positive link between patient satisfaction and a variety of patient-oriented clinical care outcomes, including in-patient mortality, treatment adherence, and improved rapport with care providers.

 Given this compelling and consistent association, it is only fitting to consistently measure and evaluate patient satisfaction.

Yet, based on a recent literature review of patient satisfaction in clinical research specifically, only a small fraction of studies (nine out of several thousand) reported systematically evaluating patient experiences during a clinical trial.

 Further, of the nine studies that reported measuring patient satisfaction, only one study used a widely accepted and validated patient satisfaction instrument (Modified Client Satisfaction Questionnaire).

 The remainder used ad hoc, investigator-developed patient satisfaction instruments.

These findings were recently corroborated at a meeting among patient engagement stakeholders from sponsor companies and contract research organizations (CRO) where the majority of companies conceded that they are not consistently measuring patient satisfaction in their clinical trials. The inconsistency and sparseness in how patient satisfaction is measured should not come as a surprise given the limited number of patient satisfaction scales developed exclusively for clinical research.

There is clearly little to no consensus on what is the most appropriate instrument for measuring patient satisfaction. This by no means suggests that organizations should be satisfied with the current state of affairs. Rather, lack of a consensus measurement-method signifies an opportunity to test out and validate different approaches for capturing patient experience in clinical research. To begin, there already exists a recognized and validated non-clinical research patient satisfaction instrument, the 8-item Modified Client Satisfaction Questionnaire. This instrument is commonly used in many different industries and has been adopted in the medical science and healthcare literature.

This measure could provide an appropriate starting point from which organizations can expand and refine (i.e., adding additional questions about different aspects of the clinical research study).

There are numerous factors that impact a patient’s clinical trial experience ranging from their relationship with clinical research staff and healthcare providers to their perceptions of the research facility, location of the study site, ease or difficulty adhering to protocol requirements and the ease with which technology solutions can be used. It is important to note that the domains that are assessed are likely to change depending on the unique and custom design of each clinical trial and the unique patient population served (e.g., demographics, social determinants). Generally, it is understood that there is no one-size-fit-all-approach and this is certainly true in the endeavors to measure the patient experience. However, there still needs to be more of a unified effort and approach among sponsor and CRO companies to capture patient satisfaction across different domains covering the clinical research experience.

As a starting point, we propose the following domains:

Patient satisfaction with different elements of the clinical research study, such as:

Study schedule (i.e., how difficult/easy was it to adhere to the scheduled visits)

Study drug (i.e., did the treatment work as expected)

Clinical research staff and healthcare providers (i.e., quality of the relationship; responsiveness of the clinical research team, etc.)

Facilities (i.e., cleanliness of research site)

Accessibility of the facilities (i.e., distance from one’s home to the research site)

Willingness to participate in another clinical trial again

Likelihood of recommending this study to someone else

Consistent assessment of these domains can be beneficial on many fronts. First, it can provide an important outlet for patients wishing to provide input and feedback regarding their experience. Countless studies have shown that with very few exceptions, patients eligible for clinical research studies are eager and willing to engage with researchers. A recent online survey, for example, found that the vast majority (93%) of patients would be “Interested in helping researchers design better trials.” The results suggest that protocol co-design, in particular, is an opportunity to partner and engage with patients.

Second, examining patient attitudes and perceptions around whether they were, for example, treated with dignity and respect can provide important clues that can help inform and bolster diversity, equity, and inclusion initiatives. This is particularly important when it concerns historically marginalized groups, such as racial minorities. A recent focus group study among Black patients revealed that those treated by healthcare providers who received specialized training to treat patients of varying skin colors, reported greater respect and dignity compared to Black patients that were seen by healthcare providers who had not received such training.

 Measuring the patient experience can go a long way in revealing disparities resulting from racial, gender, and other forms of bias that could negatively affect the likelihood of a minority patient remaining in a clinical research study.

Lastly, tracking patient satisfaction can serve as an early indicator, or proxy, that can be used to help predict relevant study-level operational outcomes. For example, it is well understood that certain study-level outcomes can take a long time to collect, sometimes taking years.

 This time lag creates a challenge for stakeholders involved in the drug development process, particularly in the face of significantly rising costs to run clinical trials. Patient satisfaction, on the other hand, can be tracked and measured from the outset of a study (i.e., satisfaction level with initial interactions with study personnel). In so doing, this assessment provides relevant stakeholders with an early indicator of how patients are connecting with study personnel and experiencing participation, which can have direct, tangible effects on outcomes like recruitment rates, dropout rates, as well as patient adherence to the study drug.

Importantly, there are a variety of methodologies for administering patient satisfaction assessments while reducing patient survey fatigue and completion burden. For example, rather than ask the patient to fill out a long survey multiple times during the study, some sites could ask half of the relevant survey questions during the first few weeks or months of the study, while asking the other half of the survey questions during the second part of the study. Alternatively, some sites may ask patients to answer all of the questions at the end of the study, while some may choose to focus on a few select domains and administer the same few questions multiple times during the course of the study to examine the longitudinal impact on the patient’s experience. These are just a few examples of how the survey questions can be administered so that patients are not overly burdened but are still given an opportunity to express their personal experience and satisfaction and inform improvement. The bottom line is, there are many different ways that patient experience and satisfaction can be measured that can fit the needs of both the clinical research site executing the trial as well as the patient.

Measuring and demonstrating the impact of patient engagement in drug development remains a work-in-process. At the same time, pressure to invest in patient-centric initiatives can at times lead to what many are calling tokenistic or virtue signaling (a false appearance of inclusiveness).

 Left unchecked, the clinical research enterprise runs the risk of becoming more ‘trial-centric’ and of overlooking and alienating the populations that we are trying to engage, elevate, and empower.

Operational outcomes, while important, should not be the primary outcomes of patient-centric practices. Instead, they should be viewed more as key secondary endpoints that are likely to be improved as a consequence of enhanced patient satisfaction. As such, we encourage organizations to take initiative and start measuring patient experience and their attitudes about that experience. In so doing, we can empirically begin to track and demonstrate whether patient-centric initiatives are meeting the primary intent of patient engagement.

*Corresponding Author, Tufts Center for the Study of Drug Development, Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111. 

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Reminding clinical research stakeholders to reprioritize routine assessment of patient satisfaction as a primary outcome measure in patient-centric activities.

Jennifer Kim

Articles

The Impact of Gender Microaggressions on Team Performance in Drug Development

Measuring Patient Satisfaction as a Primary Outcome for Patient-Centric Initiatives